Improving Health, Increasing Longevity: A Look at Childhood Obesity

Yesterday, we talked about the financial and health impact that obesity is having on our lives as American taxpayers, consumers and patients.

We showed that when it comes to obesity, state and federal governments and private insurers have been slow to respond to this public health crisis.

Today we turn our focus to the prevention of childhood and adolescent obesity.

After all, there is a 70% chance that an overweight adolescent will become an overweight adult, so targeting younger Americans really seems like the right thing to do.

And overweight children face serious medical problems of their own:

A study presented at the American Heart Association’s 2008 convention found that the artery walls of overweight and obese children look like those of an average 45 year-old, meaning that such youngsters are at-risk for heart disease and stroke at a much earlier age.

Imagine having a heart attack or open heart surgery in your 30’s, instead of your 50’s…

So what steps can policymakers, parents, and community leaders take to curb the growth of childhood obesity?

First, the newly-appointed Secretary of the US Department of Agriculture, Governor Tom Vilsack, will have the opportunity to make reforms to the Child Nutrition Act which is scheduled to come up for review in early 2009.

The Child Nutrition Act helps to regulate the National School Lunch (and Breakfast) Programs (NSLP).

The National School Lunch Program (NSLP) was started in 1947. It helps to provide free or reduced-price meals to low-income students. As of 2007, the NSLP served approximately 30.5 million lunches per day at a cost of $8.7 billion a year.

While providing a great service to low-income families, critics of the program point to the poor nutritional value of the foods served.

The reason for this is simple:

The USDA purchases hundreds of millions of dollars worth of high-fat, high-cholesterol meat products each year to benefit U.S. agribusiness.

These food products are then distributed to schools through an entitlement program.

Obtaining fruits and vegetables is an entirely different matter. Schools are on their own to make these selections, and are reimbursed at a much lower level for these products by the USDA.

Under pressure from watchdog groups like the Physicians Committee for Responsible Medicine, many school districts have reformed their practices and now serve vegetables and fruit sides, and non-dairy and vegetarian options daily or several times a week.

Mr. Vilsack and Congress should also reform the Child Nutrition Act to mandate that school lunches contain less fat content, and the USDA should increase its vegetable and fruit reimbursement rates.

Click here for a report card that ranks public school lunches nationwide.

As for other ways to reduce childhood obesity, less television and more exercise seem to be the key.

This Kaiser Family Foundation literature review found that children who spend the most time watching television or using other forms of media such as computers and video games, are more likely to be overweight than their peers.

Contrary to popular belief, this may not be simply because using media replaces vigorous exercise. Children who watch a lot of television are also exposed to more advertisements about fast food, soda, candy and other sugary edibles, which encourage them to seek out those items. These types of foods often contain high fructose corn syrup, which can lead to obesity and diabetes when consumed in large amounts.

So – who’s raising the kids? Who’s buying the junk food in the stores and letting them sit in front of the television eating the junk food? Might be a good idea to take a look at parenting and parental knowledge when it comes to kid’s diets.

Along that vein, several states are considering or enacting legislation requiring that students learn about nutrition in schools and/or participate in some form of physical activity during the day.

While all 50 states and the District of Columbia have passed legislation related to physical education and/or physical activity in schools, only 13 have enforceability language and only four have sanctions or penalties if the programs are not implemented.

In effect, there is still work to be done at the state and federal levels on this issue.

As a former daycare worker, I can attest to the low quality of government-subsidized food provided for children from low income homes. How can we expect these children to catch up to their peers from more stable backgrounds when we’re feeding them nacho cheese twice a week?! Furthermore, physical activity programs, along with creative and performing arts programs, are the first to be cut when schools’ budgets get tight — or when test scores are too low, and teachers are forced to spend their student time tediously “teaching to the test” — so as not to lose funding from No Child Left Behind. Without enrichment from as music and art programs, a daily period of physical activity (which has been proven to help childrens’ concentration in class) and well-balanced meals, how can we even pretend we are doing anything other than leaving these children in the dust. Those who complain about populations of people who depend on welfare and government hand-outs ought to consider whether we’ve given children from low-income households any other choice than to follow the same patterns as their parents. We owe future generations of our fellow citizens better.

Obesity has been defined as when excess body fat accumulates in one to where their physical overgrowth makes the person unhealthy to varying degrees.

Obesity is different than being overweight, as others determine obesity to be of a more serious concern. While obesity is not a disease, it is a serious health risk for one who has this risk.

As measured by one’s body mass index (BMI), one’s BMI of 25 to 30 kg/m is considered overweight. If their BMI is 30 to 35 kg/m, they are class I obese, 35 to 40 BMI would be class II obese, and any BMI above 40 is class III obesity.

Presently, with obesity affecting children progressively more, the issue of obesity has become a serious public health concern. In the United States, greater than one third of all citizens are obese, and this number continues to progress.

Approximately half of all children under the age of 12 are either obese are overweight. About twenty percent of children ages 2 to 5 years old are either obese are overweight. The consequences of these stats on our children are very concerning, considering the health issues they may or likely experience as they get older.

Worldwide, nearly one and a half billion people are either obese or overweight. In the United States, about one third of adults are either obese or overweight.

Women of low socioeconomic status are likely to be twice as obese compared with those who are not at this status. It is now predicted that, for the first time in about 150 years, our life expectancy is suppose to decline because primarily of this obesity problem.

Morbid obesity is defined as one who has a body mass index of 30 kg/m or greater, and this surgery, along with the three other types of surgery for morbid obesity, should be considered a last resort after all other methods to reduce the patient’s weight have chronically failed.

Morbid obesity greatly affects the health of the patient in a very negative way. It has about 10 co-morbidities that can develop if the situation is not corrected. Some if not most of these co-morbidities are life-threatening.

One solution beneficial in many cases of morbid obesity if one’s obesity is not eventually controlled or corrected is what is known as gastric bypass surgery. This is a type of bariatric surgery that essentially reduces the volume of the human stomach in order to correct and treat morbid obesity by surgical re-construction of the stomach and small intestine.

Patients for such surgeries are those with a BMI of greater than 40, or a BMI greater than 35 if the patient has co-morbidities aside from obesity. This surgery should be considered for the severely obese when other treatment options have failed. The standard of care illustrating as to whether this surgery is reasonable and necessary should be clarified.

There are three surgical variations of gastric bypass surgery, and one is chosen by the surgeon based on their experience and success from the variation they will utilize. Generally, these surgeries are procedures related to gastric restrictive operations or mal-absorptive operations.

Over 200,000 gastric bypass surgeries are performed each year, and this surgery being performed continues to progress as a suitable option for the morbidly obese. There is evidence that this surgery is particularly beneficial for those obese patients that have non-insulin dependent Diabetes Mellitus as well.

It is believed that the results of this surgery to correct morbid obesity greatly limits or prevents such co-morbidities associated with those who are obese. Yet about two percent of those who undergo this surgery die as a result from about a half a dozen complications that could occur.

However, the surgery reduces the overall mortality of the patient by 40 percent or so, yet this percentage is debatable due to conflicting clinical studies at times.

Age of the patient should be taken into consideration, as to whether or not the risks of this surgery outweigh any potential benefits for the patient who may have existing co-morbidities that have already caused physiological damage to the patient.

Also what should be determined by the surgeon is the amount of safety, effectiveness, and rationale for a particular patient regarding those patients who are elderly, for example.
Many feel bariatric surgery such as this should be considered as a last resort when exercise and diet have failed for a great length of time.

If a person or a doctor is considering this type of surgery, there is a website dedicated to bariatric surgery, which is: http://www.asmbs.org,